Provider Demographics
NPI:1295193811
Name:GINGRICH, KRISTEN M (LCSW, CADC, CCS)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:M
Last Name:GINGRICH
Suffix:
Gender:F
Credentials:LCSW, CADC, CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:186 FALMOUTH RD
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04062-4542
Mailing Address - Country:US
Mailing Address - Phone:717-342-4906
Mailing Address - Fax:
Practice Address - Street 1:24 STONE ST STE 201
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-5209
Practice Address - Country:US
Practice Address - Phone:207-623-3712
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-10
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC174721041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical